APA: Virtual Reality May Help Relieve PTSD

Action Points

Explain that in a small randomized controlled trial, virtual reality exposure therapy relieved symptoms of post-traumatic stress disorder significantly better than did conventional treatment with medication and talk therapy.

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

NEW ORLEANS -- Exposure therapy using virtual reality appears to be more effective for alleviating symptoms of post-traumatic stress disorder (PTSD) than traditional treatment among members of the military who have served in Iraq or Afghanistan, researchers said here.

In a small study, appreciably more patients had a significant improvement in symptoms with virtual reality exposure therapy, compared with those who only received conventional PTSD therapy, which included medication and talk therapy (P<0.01).

Robert McLay, MD, PhD, of the Naval Medical Center San Diego, presented the findings at a press briefing at the American Psychiatric Association meeting here.

"PTSD is often very resistant to most forms of therapy," McLay said. "Medications can make a difference, but usually that's a very small difference."

PTSD has emerged as a significant problem in members of the military returning from deployment in Iraq or Afghanistan. Exposure therapy has been shown to be relatively effective in conditions ranging from phobias to stress disorders, McLay noted.

"So we take an idea that seems to be working and ask, what can we do to make that better?"

One of the potential problems of exposure therapy is being able to administer it in a controlled environment, since the therapy involves the patient reliving the trauma, which can be overwhelming.

"We can use the [virtual reality] simulator to allow them to do so in a controlled way," McLay said.

To test their hypothesis, the researchers enrolled 20 active duty members of the military with chronic PTSD related to service in Iraq or Afghanistan in a randomized controlled trial at military hospitals in Southern California. Most of the enrollees had failed at least one previous treatment. Half of the patients were randomly assigned to Virtual Reality Exposure with Arousal Control (VRE-AC) therapy, while the others received the standard treatment for combat-related PTSD.

The same researchers had conducted prior trials to test the feasibility of VRE-AC and found that 75% of enrollees had a dramatic improvement in symptoms.

The VRE-AC therapy used in the current trial involves a simulation of an Iraqi city, and a psychiatrist, in collaboration with the patient, controls all aspects of the virtual world -- the amount of violence, traffic, sounds, and so on. At the same time, the researchers monitor the patient's respiration, heart rate, and skin conductance.

McLay noted that virtual reality therapy "is not done by the machine. The machine is only a tool."

Patients went through VRE-AC treatment up to two times per week and were then followed for 10 weeks.

The researchers found that 70% of the patients in the virtual reality group experienced at least a 30% drop in symptoms as measured by the Clinician-Administered PTSD Scale (CAPS), compared with only 11% in the standard treatment group (one patient in this group dropped out of the study), which was significantly different at P<0.01.

McLay cautioned that the findings can't determine whether the virtual reality alone is the active component of treatment. "It could be a therapist effect," he said.

David Spiegel, MD, associate chair of psychiatry at Stanford University in California, who was not involved in the study, said that's certainly a limitation, but it highlights that "cognitive psychotherapy is effective. You need a therapist there, not just a machine."

Overall, he said the idea of virtual reality exposure therapy "is a good one" because "one of the hallmarks of treatment of PTSD is controlled exposure."

"You want them to be exposed in a way that they don't feel retraumatized," Spiegel said, lest they drop out of therapy. "This may be an answer to that."

McLay said he is involved in two ongoing studies with a more comparable control group in order to discern the potential effects of the technology.

He added that other centers are also investigating the technology in populations ranging from victims of bus bombings in Israel to survivors of Sept. 11.

The technology was given to the researchers by Virtual Reality Medical Center in San Diego.

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